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Today, we have a guest post written by one of our Project Conservators, Lianyu Feng.

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Lining is used to give support to an original paper document or artwork. When paper deteriorates, it gradually loses its strength, thus becoming brittle and weaker. Any unsuitable handling can cause further damage such as tearing, and could even cause the paper to fall to pieces. In our Unexplored Riches in Medical History project, such weak documents cannot be handled or read and so can’t be used for research. In order to repair these torn and fragmented documents and make them usable again, we line them with a supporting material.

The document below had many small fragments before it was repaired. These fragments needed to be re-attached to the document. Lining is a good method to do this in a fast way and give the whole document more support.

Below is another example showing severe deterioration, which has made the document fall to pieces. It would be impossible for anyone to read this easily.

A light box, such as the one below, helps us to place the fragments into the right position. It makes it easy to see where the gaps are, and then we can align the fragments into the exact positions.

If the object contains ink which is not sensitive to water, wet lining using Japanese tissue and special conservation adhesive is one of the most common methods. As lining should not obscure the information on the object, the back of the document or the side which contains the least information is the most suitable for lining. For example, the document below has had Japanese tissue placed on the back of it so as not to obscure the text on the front.

When wet lining has been carried out, the document will then need to dry. The document is dried under tension; this means that the document stays flat as it dries. This flattens existing creases and prevents new ones from appearing.

Once a document has been lined, the object will be stronger, and completely flat, with all the fragments having been re-attached and any tears stabilised. A lined document is both easier to handle and looks better aesthetically.

Below, we return to the document we saw earlier, which had completely fallen to pieces. Here it is after lining. All the pieces have been placed in the right position, although unfortunately some parts are still missing, such as the line in the middle. However, we can now handle and read this letter without difficulty.

Today, we have a guest post written by one of our Project Conservators, Rebecca Regan.

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During this project the conservators frequently come across severely crumpled or tightly folded documents within the children’s case files. Sometimes the documents have been squashed in this shape for over a hundred years. They need to be flattened so that they can be read by researchers and archivists. Documents which have to be repaired are also flattened first as this makes the repair process quicker, simpler and more effective.

Many of the documents are very fragile and brittle so this flattening process needs to be done slowly in order to prevent further damage. One of our most commonly used methods is called ‘humidification’. This entails placing the documents in an enclosed container, raising the moisture levels of the air inside the container slightly, in a controlled way, and waiting for the documents to relax sufficiently before unfolding and flattening any distortions.

Trays of documents being humidified

Close-up showing the fine water vapour entering the humidification tray

The opened documents are then allowed to dry out completely while under pressure. Here you can see this being achieved using a traditional nipping press:

The documents in the press are protected from surface damage by being sandwiched between layers of heavyweight blotting paper and a special inert plastic material which prevents the damp documents from sticking to the blotting paper.

This document was found wedged at the bottom of an envelope. It was extremely brittle and hard and impossible to unfold even slightly:

Here is the same document after humidification and pressing.

It turned out to be a foster mother’s note about the child in her care. She describes her as a nice girl who is fond of her foster sister.

This photograph shows what can happen if the humidification process is omitted. At some point in the past, these fragile, brittle documents were forced flat. Unfortunately the resulting severe damage is only too evident.

In contrast, here is a case file, after conservation treatment during this current project, where all the brittle documents were humidified before pressing:

The case file is now stabilised and easy to handle and read. It has become once more a useful and interesting historical resource.

Today we have a guest post written by one of our project volunteers, Leonora Fane-Saunders.

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Some of the most interesting documents found in the case files are letters written by the children in care to family and friends. They reveal much about life in the homes and about a child’s interests, talents and character.

Edward Gurt was eight years old when an application to The Children’s Society (then the Waifs and Strays Society) was made by Miss Bessie Peacock, the former employer of Edward’s mother. Edward’s father had died, which left his mother struggling to support him.

On the twenty fifth of March 1907 Edward was initially admitted into St Martin’s Home for Crippled Boys, Surbiton, Surrey, due to talipes varus, a congenital deformity of the foot. However, after to a successful operation, Edward was deemed fit for an ordinary home and was transferred first to the Islington Home in London and then to St Michael’s Home in Chislehurst, Kent.

Little is heard about Edward until May 1911 when there is a letter from the head teacher of his school stating that Edward suffered from a heart condition and poor eyesight and would not be allowed to return to school until a doctor pronounced him fit to. As a result Edward was transferred to the Devon House Home in Margate, Kent; this home wasn’t run by The Society, but it specialised in looking after ‘delicate’ children. It was from here that he wrote two very interesting letters to his mother.

July 2nd 1911.

Dear Mother,

I am writing to tell you that I am getting used to this new home, here in Margate. It is a nice place but I shall be (able) glad when I can come home and get some work. I am sorry I did not write before. How are Kate, and Harriett getting on. I don’t suppose you will be able to come and see me, because I am too far away from you. We are having very fine weather here, and I enjoy myself.

At the Coronation we saw some races in the park, and at night when it was getting dark we saw some fireworks. Please will you send me six penny stamps. Last Wednesday the master gave us all a treat and we had races and tea up in the field. Every Saturday we have a game of cricket.

I remain your loving Son Edward xxxxx

To Harriett & Kate xxxx xxxx.

Please write soon.

November 12th 1911.

Dear Mother,

I hope you are still well & happy. I have not heard from Jack yet but when I have I will let you know. If I come home it will cost 3s 1d but I shall have to out

how long I can stay. I shall be glad when I can come home. Could you send me some stamps. My stamp- -album is nearly full. I have a page of United States, Austria, France & Germany. We all had a magic- lantern last night and

I enjoyed it very much. I shall be glad when I can live in London again. As Jack come home from Canada yet, or, is (his) he coming at all. Give my love to Kate & Harriett. I should like to see you and Kate again soon & also Gladys. I hope Stanley still likes

living in Surrey. I think I must close now.

I remain your loving Son Edward xxxx.

These letters reveal a budding artist and avid stamp collector who may be a little home-sick and missing his family. They show he has a tendency to write in dialect: as instead of has. The letters also depict a little of what life was like for Edward and the other boys in the Margate Home. It is clear that sports were encouraged in the form of a weekly cricket game. A picnic and a magic-lantern (an early projection system and forerunner to movies) were provided as treats for the boys. Interestingly, these letters mostly describe special events in Edward’s life, such as the fireworks in celebration of the coronation of King George V.

Sadly due to Edward’s heart condition The Society found it difficult to obtain either training or a job for him. After several fruitless enquiries Edward was eventually returned to his mother in 1912. No further information is given in his file, which leaves us wondering if he ever built up the artistic talent shown in those letters.

Is it possible to become ill through reading too much? It’s certainly something that was thought possible in Arthur’s case 114 years ago.

Arthur had been living in Newbury, Berkshire, with his mother and his two younger siblings. His father had died and his mother had run away from an abusive second marriage, leaving her struggling to earn enough money to support the family by herself. We are told that her earnings came from needlework and an occasional lodger.

When Arthur was 14 years old, he was sent to the Workhouse for a fortnight, and from there, in the year 1900, an application was made for Arthur to be taken into the care of The Children’s Society (then known as the Waifs and Strays Society). The reason given for sending Arthur into care is rather unusual. See the application form for yourself:

Dear Sir

This boy left school two years ago & as he was a clever promising boy some friends helped the mother to apprentice him to a printer. The work appears to have disagreed with him, being too confined for his health, he is a delicate lad & easily led & he has been spending his master’s time & his own money in buying & reading a number of penny dreadfuls. By this means he has quite worried & weakened his brain & he became so unmanageable three weeks ago that his mother took him to a doctor, who sent him to the Workhouse for a fortnight on a cerf certifi cate as suffering from reading mania. No one can imagine that there is anything whatever the matter with the boy’s brain, he answers all questions most intelligently & as you will see the doctor who examined him yesterday saw nothing wrong with him. But he had to be returned home & all the mischief will begin again unless he is put under proper control. He ought to have plenty of fresh air & be carefully controlled & train ed & I think then he would turn out well.

We are anxious he should be received into the Hedgerley Farm Home, for which the Guardians are willing to pay, we have a great opinion of the training there, as exemplified by a lad from here who was at Hedgerley for a year & has since done very well. His mother has been married twice & was oblig ed to leave her 2nd. husband he became mad & threatened her life & his own & now she ekes out a spare livelihood for herself & the three children & she cannot control this big boy of 14

yrs. truly (Miss) Caroline A Talbot ‘Lady Gdns [Guardians]’

I’m sure you’d agree that the main reason given here is a strange one! Nowadays, I doubt anyone would complain that a young person was reading too much. Not only that, but that ‘reading mania’ would be diagnosed by a doctor as a certifiable medical condition seems really quite strange over 100 years later.

An important point to note is that it is not just any books that Arthur was reading but penny dreadfuls. These books were so called because they were cheaply printed and not thought to be very good for the reader. They usually contained sensationalised, escapist stories that were popular with young people like Arthur. The fact that a doctor could diagnose Arthur as suffering from ‘reading mania’ suggests that penny dreadfuls were widespread enough in the early 20th Century to cause general public concern.

If this moral panic at reading sensational stories sounds a little odd to our ears, we could instead try to consider a modern equivalent. Today, for example, there is a lot of concern about video games, particularly violent ones. If a doctor in 2014 certified that a young person was suffering from some sort of mental illness brought on by playing too many violent video games, we wouldn’t necessarily think it was so unusual.

After all this talk of ‘reading mania’, it’s only when we read on to the bottom of the application form that we find what was, most probably, the real reason Arthur needed to be taken into care: his mother was trying to support three children by herself, while earning very little money. If this was the case, then why spend over half the page talking about the penny dreadfuls?

It’s important, when reading this or any document, not just to take it at face value. Instead we need to consider why the document was being written and if the person writing it had an agenda that they wanted to get across. In this case, the form was an application for Arthur to be taken into the care of the Waifs and Strays Society. However, not all applications were successful; the Waifs and Strays Society only had limited funds and so weren’t able to help every child that came to them. Instead, they used the application forms to decide who needed their help the most. In Arthur’s case, we can almost imagine that Miss Talbot, writing the form, was really emphasising the ‘reading mania’ to play on social fears current at the time, which she thought would help to get Arthur accepted into care.

Whether or not the ‘reading mania’ played a large part when Arthur’s case was considered by the Waifs and Strays Society, we don’t know; but we do know that his application was successful. In February 1900, Arthur was admitted into the Hedgerley Farm Home in Buckinghamshire. This home specialised in farming and the boys living there were trained in agricultural skills. Arthur stayed in the Hedgerley Farm Home for one year, after which he returned to his mother.

Overall, the medical diagnosis of ‘reading mania’ probably says far more about the social fears prevalent at the time than it does about Arthur’s health. What are your views on this? If penny dreadfuls were common today, do you think we’d still be worried about young people reading them?

Today’s case highlights a condition that was fairly common in the late-19th and early-20th centuries, although it’s not very well known today: tuberculosis, but not as you might expect.

It’s easy to think of tuberculosis as purely a lung disease, but in some cases the infection can affect other areas of the body instead. Children’s files in the archive give us examples of tuberculosis in the digestive system, the nervous system, and scrofula (being tuberculosis in the lymph glands in the neck). One of the most common tubercular diseases we’ve found, after tuberculosis in the lungs, is tuberculosis affecting the bones and joints. Often this type of infection occurred after an injury or breakage, with tuberculosis developing in the damaged bone.

Grace was living in Dinas Home For Girls in Brecon, Powys (then in Brecknockshire), when it was taken over by The Children’s Society (then known as the Waifs and Strays Society) in 1909. At this time, Grace would have been 12 years old. She was from London and had entered Dinas home through another charity, the Fulham branch of the Rescue Society, after her parents had separated. Her father had been described as “very unsteady”, with Grace and her three siblings having been neglected when under his care.

While in the Dinas Home, an abscess was found on Grace’s hand, which was identified as being the result of tuberculosis. In early 1911, with Grace around the age of 13, she had an operation to remove the abscess and was then sent to the coast for a month to recuperate. Unfortunately, the operation wasn’t as successful as had been hoped; by December another abscess had appeared on Grace’s wrist.

Grace was seen by a doctor, who recommended that her hand should be bandaged up and that she should be given complete rest and sea air. Because of this recommendation, Grace was sent to The Children’s Society’s new convalescent home, St David’s Home in Broadstairs, Kent.

In St David’s Home, Grace could receive the medical care she needed. Her hand and wrist were treated with poultices and with boracic lotion, which was an antiseptic. Grace was also found to be suffering from head lice, which was treated with sassafras. These treatments seemed to be successful and, in time, the abscess started to clear up and the swelling on Grace’s wrist went down.

After three months in St David’s Home, Grace was transferred to St Audrey’s Home in Bedford. When she arrived at St Audrey’s Home, it was found that Grace was not able to use her hands much. The healed abscess on her right wrist had left it swollen and weak, while the doctor at the home found that she also had a “poisoned” finger on her left hand. After enquiries it was found that just before Grace had left St David’s Home she had pinched her finger in an accident. It was thought that underlying tuberculosis might have caused Grace’s injured finger to go bad.

As it had been discovered that Grace was still suffering from tuberculosis, she quickly returned to St David’s Home in Broadstairs for further treatment.

By September 1912, having been in St David’s Home for a further four months, Grace was described as having put on weight and being in good health. She was now 15 years old and it was thought best to send her to a home where she could start to learn a trade to allow her to go to work when she was well enough.

In October, Grace was sent to St Barnabas’ Home in Newark, Lincolnshire. She didn’t remain in this home for long, however. By January the next year, the doctor at the home had sent on a medical certificate saying that Grace was still suffering from tuberculosis in her wrist, with the disease now in an active state.

And so, in March 1913, Grace was sent to St Anne’s Home in Clapham Park, London, where she could be examined by a doctor. The result of this visit can be seen in the letter below:

March 28th. 1913

Re Grace [surname]

I took this girl today to Mr. Boyd, 134 Harley St W, to meet Dr. Rose Turner there for an interview. Dr. Boyd sent us to X Ray Dept. Charing X They gave me no messages (although we waited for the same) as to when to go there again, nor whether she was to be made an in-patient at that Hospital.

E A Bailey Travelling Matron W. & S. Society

Dr. Turner has case in hand. 29.3.13

The x-ray must have shown signs of tuberculosis because it wasn’t long before Grace returned to Charing Cross Hospital to have an operation on her wrist. After this she would need extra medical care while recuperating, but the active condition of the tuberculosis meant that she couldn’t return to St David’s Convalescent Home in Broadstairs where the children there, already ill, might be put at further risk of infection.

Instead, in April 1913, Grace was transferred to the Westminster Union Infirmary in Lincoln’s Inn Fields, London and then to the Strand Union Infirmary in Edmonton, London. Here it is said that Grace was staying in a small ward and that “… the Doctor has ordered her special diet, extra milk &c [etcetera]”. When visited by one of The Children’s Society’s travelling matrons, Grace was found to be doing well, with her wrist weak but healed up.

This is all we hear about Grace until November 1913. By this point we find that she had been transferred to the Isolation Hospital in Ramsgate, Kent, but there are no updates as to her condition. With no further correspondence in Grace’s file, we can only guess at how she was doing. The operation on her wrist may perhaps have healed, but the fact that she was still in hospital suggests that her tuberculosis hadn’t cleared up completely and was potentially still active. The prognosis for Grace, then, didn’t look good, and without the option of the antibiotics we have today, it seems like further surgery may have been Grace’s only hope.

As sad as it is, Grace’s file gives us some interesting information about medical treatments in the early-20th Century. We find out that boracic lotion was used as an antiseptic and that sassafras was used to treat head lice. Not to mention, we have evidence of x-rays being used as a tool for diagnosis, and this only 18 years after x-rays had first been discovered.

Most importantly, Grace’s file shows us what it would have been like to live with a tubercular infection in the joints and bones. This was a disabling condition that left Grace living in convalescent homes and hospitals, unable to continue the training she had started. Even invasive surgical treatment, it seems, wasn’t able to stop the infection fully, leaving potential for the disease to return and spread to other parts of the body.

But that’s enough of me talking; here’s what the volunteers have to say themselves:

“The majority of my time involves working with and handling the case files, which go back to the 1880s! Our job is to extract medical notes and information from the case files in order to build up an online database of medical conditions that the Society dealt with.”

“I extract pieces of information from the case files and upload the information onto CALM where all the records are kept. For instance, if a record on CALM says a child went to Hospital; my role is to try and find out why that child went to Hospital. Once I have found the information needed I update it onto CALM.”

“By going through the correspondence and other documents contained in each case file, it will (hopefully!) become apparent why each child’s stay in a hospital or convalescent home was deemed necessary. This information is then added to the ‘case history’ section of the case file’s CALM record, along with relevant medical index terms. The index terms are taken from archival thesauri to ensure that they are the most suitable names for medical conditions and help researchers find the records they are interested in.”

The volunteers are a diverse and motivated bunch. I asked them why they wanted to volunteer with us:

“I felt that I needed some work experience in a history related job and I discovered The Children’s Society was offering this wonderful opportunity to archive medical documents from the 19th century. I was motivated to apply for the volunteering as it seemed such an interesting role and I thought it would be great to volunteer for such a prestigious organisation.”

“I’ve always thought that we have a lot to learn from history and projects such as this are invaluable in teaching us about people and disease. I jumped at the chance to learn from hundred year old documents, many of which have remained untouched!”

“I’d helped out TCS [The Children’s Society] with street collections previously and happy to contribute to a good cause.”

“I was hoping to broaden my experience of archives prior to applying for paid work and postgraduate course in archives. Learning about indexing on CALM is a valuable accompaniment to the cataloguing skills which I have acquired in other voluntary roles.”

This project isn’t always easy. For some volunteers the most challenging part is the condition of the documents. Our conservation team is doing a stellar job of making the files easier to handle, but those documents that haven’t been conserved yet can be tricky to use.

“You have to be flexible when dealing with the case files. From one minute to the next you can be looking at completely different files – some have mould, some are in newer formats, some are small – and you have to respond respectively.”

[The most challenging part of the role is] “Handling some of the files which are in poor condition.”

For other volunteers, the handwriting and the language from 100 years ago can take a bit of getting used to. It seems like some doctors’ handwriting is hard to read no matter when it was written!

“The variety of handwriting and how sometimes letters can be difficult to read make this the most challenging part of the role.”

“The most challenging aspect of the role is trying to read the documents correctly. The majority of the documents I read are hand written, so it takes time and focus to read the documents accurately and find the relevant information.”

“Another minor difficulty which I occasionally face is encountering antiquated names or spellings for illnesses, which can make decisions about indexing the case files more tricky.”

And then there’s the information in the files itself, which can be very moving at times:

“Inevitably, given the medical nature of the project, there are some case files which detail sad stories of children suffering and dying from diseases. It is notable how many children a century ago were afflicted with conditions such as tuberculosis and scarlet fever, which are much less prevalent in Britain today due to advances in medical technology and people’s living conditions.”

Thankfully, despite the difficult parts, the volunteers have been finding the project enjoyable:

[I’ve enjoyed] “Getting an insight into the lives of the poor and disadvantaged 100 years ago.”

“One of things I love most about my role is that no one day is the same as you deal with different children’s case files who have their own unique personality and life. Moreover, as I am currently studying modern British History, the case files really bring history to life as there is real life evidence of a number of things I have studied.”

“It is also rewarding to come across positive stories recorded in the case files, when children have overcome medical problems. A memorable example involved a boy who, having already been in hospital frequently, was accidentally hit in the eye by some putty thrown out of a window by a builder. Despite this incident permanently damaging his eyesight, he was still able to find a job and work successfully in The Children’s Society head office a few years later.”

“I have enjoyed learning about the lives of the children that were under the societies care and getting a glimpse of what life was like for them at the time.”

“I have enjoyed handling the documents and reading peoples’ personal histories. I have found reading documents that are nearly 100 years old something quite special and rewarding.”

“I have really enjoyed working with the Society. Before I started I knew little about the Society’s history or the work it does today. Handling original case files has been a fascinating window onto decades of social history and the role the Society has had in it.”

Many thanks to the volunteers for taking the time to answer my questions and, not least, for being such a great asset to this project! Thanks to their help, our knowledge of the medical information in our collection is coming on in leaps and bounds.

If you would like to learn more about volunteering for The Children’s Society, please take a look at our volunteering pages.

Sometimes in The Children’s Society Archive you come across things that you weren’t quite expecting. In the comments to the post about diphtheria we’ve been discussing the weight and height of children 100 years ago. Spurred on, I decided to do some research of my own. The results I found were a little surprising.

From 1911 onwards a detailed medical form was created for every child who was taken into the care of The Children’s Society (then known as the Waifs and Strays Society). The forms were filled in before the children came into care so that The Children’s Society could see if they needed any immediate medical treatment. An example form is shown below (click the image to see a larger version):

Question number 12 on the form asks for the child’s weight and height. As we know the date the medical forms were created and the date the children were born, this makes it possible to calculate their body mass index (BMI).

I picked out ten case files for children who came into the care of The Children’s Society in 1912 and used the NHS’ BMI calculator to work out the BMI for each of them. My results are below:

Irene – age 11
BMI in the 6th percentile

Norah – age 13
BMI in the 8th percentile

William – age 13
BMI in the 10th percentile

Ronald – age 10
BMI in the 20th percentile

Edith – age 9
BMI in the 45th percentile

Stephen – age 6
BMI in the 52nd percentile

Arthur – age 4
BMI in the 62nd percentile

John – age 8
BMI in the 69th percentile

Ada – age 13
BMI in the 71st percentile

William – age 5
BMI in the 91st percentile

According to the NHS calculator, all of the children were at a healthy weight except for William, age 5, who is classed as overweight. However, if we take a look at the BMI charts from the Royal College of Paediatrics and Child Health, we see that these charts would class both Irene and Norah as having low BMI, being below the 9th percentile.

What does this all mean? Well, I have to admit that I was surprised. For children that came into care in 1912, I was expecting far more than 20% to have a low BMI and be underweight, and I certainly wasn’t expecting any of the children to come out as overweight!

Firstly, I have to acknowledge that my sample was very small. If I had looked at 100 or 1000 files instead of 10, I may perhaps have come to a different conclusion.

As it is, I had to have a look into Irene, Norah and William’s backgrounds to see if there was anything there that might account for their BMI.

Irene, at age 11, was living with her mother. Her parents had separated due to her father’s drinking. Trying to find work, Irene’s mother had moved to London, where she and Irene were staying temporarily with a friend. Job hunting, however, was not easy. With no job and no way to provide for the family, the only option was be for Irene to be taken into care.

Norah, at age 13, was living with her parents and two siblings, with both of her parents in regular work. Norah had been found stealing twice and so was committed by a police court to go to an industrial school for rehabilitation. What Norah had been found stealing and why is not known, but considering that she had a low BMI, poverty and a lack of food may well have had something to do with it.

William, meanwhile, at age 5, was overweight. His parents were separated and his mother was struggling to find work. This makes William’s high BMI a little confusing until we realise that because of his mother’s unemployment, William had been taken into a foster home, where his father and a charity were paying for his upkeep. William came into the care of the Waifs and Strays Society because his foster mother was no longer able to look after him.

So there we have it: ten children and not nearly as many underweight as I would have thought. Cases of malnutrition certainly happened, amongst parents as well as their children, and we have the files detailing their stories, but just how frequent those cases of malnutrition were, we don’t yet know. Time for some more in-depth research with a larger sample of cases. Anybody out there up to the task? Do email us (Hidden-Lives-Revealed@childrenssociety.org.uk) if you are, or if you would like to use The Children’s Society Archive for any other research projects that you have in mind.

The story of Phyllis is a particularly sad one. Her father, who had worked on a farm, died of heart failure caused by over-exertion and exhaustion. This was in 1903 when Phyllis was three years old. Her mother was left with six children and another on the way. They were living in Kenton in Middlesex.

A month and a half later and Phyllis’ mother was struggling. Phyllis’ eldest sister, Dolly, was working as a servant and living away from home. Another of Phyllis’ siblings went to live with relatives, but this still left four children for Phyllis’ mother to provide for.

The shock of her husband’s death had made Phyllis’ mother unwell, so much so that the family’s doctor thought she would need to have a serious, and potentially fatal, operation. She wasn’t working and the family was living in temporary accommodation, which they would soon be forced to leave. For all these reasons an application was made for Phyllis and her elder sister, Ida, to enter the care of The Children’s Society (then known as the Waifs and Strays Society).

One month later, both Phyllis and Ida entered The Society’s Lampson Home in Dulwich, London. Here they both stayed until 1908 when Ida returned back to their mother. At this time their mother was unwell again, as was their grandmother who had been helping her. Ida was 15 years old by this point; she returned home to help her mother, and the intention was for Ida to go to work in domestic service once her mother was well again and no longer needed assistance.

As she was only eight years old, Phyllis remained in the Lampson Home. We don’t hear anything more about her until a year later, when there is the following letter:

500 Lordship Lane. S.E. May 13/09

Lampson Home

Dear Mr. Rudolf,

It will grieve you to hear that Phyllis [surname] [died] on the 9th. inst. [instant] at Guy’s Hospital after an operation for Appendicitis. She was a very good girl, and we are all much saddened by her loss. We have arranged for the funeral at Honor Oak Cemetery at 11.30 on Saturday next.

Yours sincerelyThs [Thomas]Douglas.

Another letter tells us something about Phyllis’ character:

… she was one of the nicest little Girls in the Home & a great favourite with us all & also with her teacher & her school-fellows, her teacher was particularly fond of her.

Sadly for Phyllis, it seems that the operation wasn’t able to save her, despite having been treated at the prestigious Guy’s Hospital in London. The causes of her death are given as appendicitis, peritonitis (inflammation of the lining of the abdomen) and heart failure.

Appendicitis was first named in 1886 and surgery to treat the disease started to become more common after that point. Most famously King Edward VII had to postpone his coronation in 1902 in order to have urgent surgical treatment for appendicitis. Edward VII’s operation was successful but, sadly, not everybody survived the new surgical technique. From what we have found so far in the Unexplored Riches in Medical History project, appendicitis was fatal in 40% of cases of the disease. These figures only come from a small sample, so they are likely to change as the project continues, but it does suggest that surgery to treat appendicitis over one hundred years ago was not any way near as successful as it is today.

In many cases, it was not the surgery itself but complications of the disease that proved to be fatal. Mortality rates were high for people, like Phyllis, who were also suffering from peritonitis, which is an infection of the lining of the abdomen. Surgery to treat appendicitis would remove the infected appendix, but if the infection had already spread to the rest of the abdomen, there was little that could be done. Mortality rates only began to drop when antibiotics started to be used alongside surgery in the 1940s and 1950s.

Unfortunately for Phyllis, in 1909, with her complications her prognosis wouldn’t have been good. Surgery would have been her only hope for treatment, but it seems that her disease was so far gone that even that wasn’t enough to help her.

Hospital admissions with rickets in England increased from 561 in 2008/09 to 702 last year. January and February are the worst months because of the low levels of UV light. Observations suggest a link with some children not playing outside. The issue was covered recently in the [London] Evening Standard (13.1.14).

Over 5% of the children who passed through The Children’s Society’s care between 1881 and 1917 had rickets recorded in their case files. Below are extracts from various cases to illustrate the situation in which rickets developed and a range of its impacts.

Three year old Lydia “lives in unhealthy street (in Hackney), and never goes out during the last three months I have known it. She sits with her feet under her, not attempting to walk, and seems to require nourishment and care. The room constantly is so close and smelly it is not conducive to the child’s health, and the mother is too deformed to do her own scrubbing. I think it one of the saddest cases I have ever known”.

The medical certificate for Annie aged six records rickets resulting in bowed legs and curvature of the spine, but “with proper care she is said to be curable”. Almost ten years on, boarded out in Suffolk, she is not considered “capable of carrying heavy weights or doing much hard work. … She takes great pleasure in, and does needlework nicely”.

With six year old Allan from Teesdale, rickets in both legs and wrists had left him “hopelessly crippled unless the deformity is corrected by operation”. The file does not record whether he had that operation. After seven years in Bradstock Lockett Home in Southport, he returned to his mother.

Some children did have their ‘rickety’ condition alleviated by surgery, as in this case below. (Like all the images in this blog, click on the image below to see a larger version.)

Others required special medical or ‘surgical’ appliances, for which funding had to be secured, as in this Welsh case:

Another rickets case, Sarah, originally from Beverley, Yorkshire was “close upon 15 – but no bigger than a child of 8 – and thus quite debarred from domestic service as she is almost a dwarf”.

With Margaret from Oxfordshire, her rickets developed soon after birth deformities, such that as an eight year old she could not use her legs beyond standing a little. However, she could use her arms well and do needlework. At nearly 16, “she is deformed, height 4ft 3in – not a girl suitable for service – does housework very nicely but her height and limbs are very much against her. She has been through our laundry, but complains of her legs hurting her, after standing or walking far.”

Hopefully, raising the alert about rickets will avoid our generation of children any of the pain, discomfort and disabilities suffered in Victorian and Edwardian times.

Thomas’ father died from congestion of the lungs in 1891 when Thomas was 7 years old, leaving a widow and four young children. The family lived in Islington in London and the situation must have been hard for Thomas’ mother who was a cleaner, earning 4 shillings per week, which equates to only around £12 per week in today’s money.

With an extended family who couldn’t afford to help, the only option for Thomas’ mother was for her to place her children into care so that she would be able to work full-time in domestic service.

A medical form completed when Thomas entered St Michael’s home suggests that Thomas was suffering from a ‘condition’. The exact nature of this condition isn’t stated on the form, although the doctor’s opinion was that it wouldn’t need medical treatment.

Everything becomes clearer in the following letter from St Michael’s home to The Society’s head office, dated 1893:

Dear Mr. Rudolf.-

Mr. Peek is much vexed at the intrusion of the 21st. for which I enclose a cheque from The Hone. [Honourable] Mrs. Cuthbert Peek for £5. I must therefore ask you as soon as possible find a vacancy for Thomas [surname]. He is a sharp boy. & would do well in learning an industry such as printing or carpentering

& is not of the sort to make a good indoor servant. I am truly grieved to part with any of them just yet. for they are all doing well in every respect. Thomas
[surname] suffers constitutionally from excima [sic] & perhaps inland air would be better for him than sea. for these two reasons I decide on asking you to make arrangements for his being received elsewhere. I will send you the tax papers early in the week. you will be aware of course that I have not received a cheque from you since Oct 11th.

I remain Yours very truly J Waring

From this letter, we see that Thomas was suffering from eczema. For a reason that is not entirely clear, it appears that one or more boys had to leave the home. In particular, it was thought that living near the coast wasn’t helping Thomas’ condition and that the air found further inland might be better for him.

Instead of moving inland, however, we find next that Thomas was moved to another home on the South Coast; this time to Bognor Home for Boys in Sussex. Sadly, no correspondence about this move survives, so we don’t know if this move to another costal home was due to conflicting medical advice or not.

After staying in hospital for two weeks, Thomas was discharged back to the Bognor Home. A letter from the hospital states that he was ‘quite cured’.

Sadly, this prognosis appears to have been overly-optimistic, as two months later there is the following note from the Bognor home:

Could lotion & ointment used by [Thomas’ surname] in “Skin Hospital” be sent us?

In response, Thomas returned to London to be seen by the doctor who had treated him at the hospital. We don’t know the exact outcome of this visit, but it is possible that the doctor gave Thomas a prescription for more medicine.

The next year, when Thomas was 13 years old, he was transferred to the Diocesan Home for Boys in Cambridge, which had recently been taken over by The Society. While he was in this home, a letter tells us that he was visiting hospital once a fortnight for treatment for his eczema, which was described as ‘getting better’.

Thomas was now of an age where he could begin to learn a trade. It was thought that Thomas would be well-suited to farm work and so in 1897 he was sent to Standon Farm Home for Boys in Staffordshire, which specialised in agricultural teaching. His training appears to have gone well as just over a year later, when Thomas was 15 years old, he went to work for a farmer in Market Drayton in Shropshire.

Thomas stayed in this job for one year, then left to go live with his mother who had moved to Huddersfield. Whether he was still continuing his hospital visits at this time, we don’t know.

This case, like so many of those that mention medical treatment, is tantalisingly vague. We know that Thomas was visiting hospital and that he had been given lotion and ointment to help with his eczema, but we don’t know exactly what those lotions, ointments and hospital treatments were.

Most intriguing for me is the fact that sea air was thought to be bad for eczema. In the late-19th Century so many diseases and conditions were treated with exposure to fresh sea air that it seems strange to find a case where it was recommended that sea air be avoided. If you know why this recommendation might have been made, I’d be really interested to hear your thoughts.